Anaemia

Question 1

Definition of anaemia

Answer 1

Hb < 130 (males)

Hb < 115-120 (females)

Question 2

How do you classify anaemia based on mrohology (MCV)?

Answer 2

Low MCV = microcytic anaemia

Normal MCV = normocytic anaemia

High MCV = macrocytic anaemia

Question 3

Causes of microcytic anaemia

Answer 3

Conditions that affect haemoglobin

• Fe deficiency
• Thalasemia
• Sideroblastic anaemia Anaemia of chronic disease* (can be, usually normocytic)

Question 4

Causes of normocytic anaemia

Answer 4

Normal RBC production but decreased production/increased losses

Acute blood loss

Bone marrow failure

Haemolysis* (can be macrocytic)

Hypothyroidism (direct effect on EPO)* (can be macrocytic)

Renal failure (Decreased EPO)

Pregnancy

Anaemia of chronic disease*

Question 5

Causes of macrocytic anaemia

Answer 5

Folate/B12 deficiency

Alcohol Liver disease

Haemoloysis*

Hypothyroidism*

Myelodysplastic syndromes

Cytotoxic drugs

Bone marrow infiltration

Question 6

Causes and blood film key features of Fe Deficiency

Answer 6

Microcytic, hypochromic

Variation in size and shape (ansiocytosis, poikilocytosis)

Bleeding - menorrhagia, upper/lower GI bleeding, hookworm

Malabsorption - coeliac disease, IBD

Diet - especially toddlers and elderly

Question 7

Causes and key blood film features of Megaloblastic anaemia

Answer 7

Folate/B12 deficiency

Folate

• Diet
• Drugs - methotrexate, trimethoprim, azithroprim
• Malabsorption B12
• Pernicious anaemia (loss of intrinsic factor/decreased gut absorption)
• autoimmune gastritis/gastrectomy, terminal ileum disease (crohn’s disease, resection)
• Special diet

Macrocytic anaemia with ansiocytosis (variation in RBC size)

Hypersegmented polymorphs

Question 8

How can normocytic anaemia be further categorised (2 ways)?

Answer 8

According to reticulocytosis and whether they cause pancytopenia

(+) With Reticulocytosis

• haemolysis, acute blood loss

(-) Without Reticulocytosis

• bone marrow failure, hypothyroidism, renal failure, anaemia of chronic disease

(+) Associated pancytopenia

• Bone marrow failure

(-) No associated pancytopenia

• CKD
• Chronic disease

Question 9

How can macrocytic anaemia be further categorised?

Answer 9

Megaloblastic and non-megaloblastic

Megaloblastic

• B12/folate deficiency
• Cytotoxic drugs

Non-megaloblastic

• Alcohol
• Liver disease
• Haemoloysis*
• Hypothyroidism*
• Myelodysplastic syndromes
• Bone marrow infiltration

Question 10

What is the pathophysiology of anaemia of chronic disease (3 mechanisms)?

Answer 10

1. Decreased production and efficiency of EPO
2. Impaired use of iron in erythropoiesis
3. Decreased RBC lifespan due to cytokine effects

Question 11

Causes of anaemia of chronic disease

Answer 11

Chronic infection

Inflammation - rheumatoid conditions, vasculitis

CKD

Malignancy

Question 12

Signs & symptoms of chronic anaemia

Answer 12

Decreased oxygen delivery

• Exertional dyspnea
• Dyspnea - Fatigue
• Pallor

Signs and symptoms of hyperdynamic circulation

• Bounding pulses
• Palpitation
• Flow murmur
• Worsening symptoms if underlying heart or lung disease

Question 13

How can anaemia be classified based on pathophysiology?

Answer 13

1. Blood loss
2. Decreased production
3. Increased destruction

Question 14

Sources of blood loss leading to anaemia

Answer 14

Gastrointestinal tract - haematemesis, melena, PR bleeding, altered bowel habit, LOW

Urinary - haematuria

Menstrual loss - menstural hx

Chronic recurrent epistaxis

Hereditary AVM

Question 15

Causes of anaemia from decreased production

Answer 15

• Anaemia of Chronic Disease (Chronic renal failure, Rheumatological disorders, Malignancy)
• Bone marrow infiltration (leukaemia, lymphoma, myeloma, myelodysplastic syndromes, bone mets)
• Endocrine – hypothyroid, renal failure (decreased EPO)
• Nutritional Deficiency (B12 folate iron)
• Infectious – acute or chronic (TB, HIV, HCV, CMV, EBV, parvovirus)

Question 16

Signs & symptoms of increased RBC destruction (haemolytic anaemia)

Answer 16

Dark urine

Jaundice (increased bilirubin)

Gallstones

Family hx of splenectomy, cholecystectomy

Increased haptoglobin

Decreased urinobilinogen

Question 17

Example of what type of anemia?

Answer 17

Fe-Deficiency

• Microcytic, hypochromic

2nd image is more chronic - showing variation in size and shape (polikilocytosis, ansiocytosis)

Question 18

Describe the changes in:

1. Serum iron
2. Transferrin/TIBC
3. Serum ferritin
4. Soluble transferrin receptor

for each of:

1. Fe deficiency
2. Anaemia of chronic disease
3. Thalasemia

Answer 18

Lower the MCV the lower the Hb in Fe-deficiency,

however, in thalaesmia the MCV will be very low but the Hb might be that low

Question 19

Key features of thalasaemia on blood film

Question 20

Define/role/function these terms:

1. Ferritin
2. Serum Fe
3. Transferrin
4. TIBC
5. Transferrin saturation

Question 21

Clinical features of Fe-deficiency anaemia

Answer 21

Anaemia – fatigue, pallor, exertional dyspnea

Koilonychia (spoon-shaped nails)

Angular cheilosis
Glossitis

Question 22

Features on pathology of haemolytic anaemia

Answer 22

Elevated LDH ( red cell enzyme)

Elevated uncongugated Bilirubin (from haem breakdown)

Reduced haptoglobin ( carries free Hb)

Blood film
– Spherocytes, bite cells, fragments,

– Nucleated red cells, polychromasia

Directcoombs test - Ig on surface of red cells

Urinary free Hb

Plasma free Hb